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JCAHO Targets Medication Safety

Kate Traynor

Pharmacists in home care and hospital settings received a glimpse Monday of how the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) intends to conduct surveys next year.

Darryl S. Rich, Pharm.D., M.B.A., FASHP, JCAHO director of surveyor development and management, said medication safety tops the accrediting group’s list of important issues.

"Surveyors are going to be much more concerned about the safety of the medication-use process than anything else," Rich told a group of ASHP Summer Meeting 2002 attendees.

Also emphasizing this message was Kenneth G. Hermann, Pharm.D., M.H.A., hospital consultant for Joint Commission Resources Inc., a JCAHO subsidiary.

"In essence, medication safety is going to be a core standard," Hermann said. He described core standards as those that "run across all programs" surveyed by JCAHO, not just hospitals and home health agencies.

In an interview after the educational session, Rich said that JCAHO has dropped its intention to allow hospitals with a computerized prescriber order-entry system to check medication orders retrospectively rather than prospectively—a proposal that had elicited many objections from pharmacists and physicians.

A medication-safety issue that Hermann said is particularly problematic at hospitals is the proper labeling of certain medications.

"One of the biggest findings, as we do surveys," Hermann said, "is the lack of labeling on syringes" containing medication that will not be administered right away. "That’s a very dangerous activity," he said.

Hermann described another medication-safety issue of concern to JCAHO—the need for health care organizations to know in advance how to respond to an adverse event.

"When you have an adverse event," he said, "how do you respond? What are you looking for? What are the common symptoms and signs?" Hermann also noted that hospitals must have developed "special procedures and policies for medications that have high potential for adverse drug events."

Another area of increasing concern to JCAHO is emergency preparedness.

"We now will have enhanced emergency-preparedness requirements in the wake of 9/11," Rich said. He noted that last September’s terrorist attacks revealed problems that affected home care organizations.

"There was a lot of disruption of services, a lot of patients who were dumped off onto home care services to clear out hospitals for those patients who were expected to come in," Rich said. "Some of these patients were much ‘higher duty’ than most home care organizations were used to."

To prevent such disruptions in the future, Rich advised home care organizations to participate in local emergency-preparedness planning. "There are going to be a lot of new requirements [in this area]," Rich warned.